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`` 1012UY44IV 4 4646138 ENVIRONMENTAL HEALTH s PAGE 01 <br /> ENVrR0)N'1fN`lt`AL MALTS[DEP.RTN ENT ' <br /> 2008 304 East Weber Avenue,3111 Floor, Staorktu E,CA 95202.23.to)r �"' <br /> Tclephunc;-(209)4,68.3420 Far,(2019)464-0138 'eb;atu+w.sjgov <br /> .P LIC RECORDS RELEASE APPLIC.ATnO.N <br /> API�'L[CAIVT: . �6lti.I CuRR � gUStNES51AG>~N�Y_' E� C 6ea�u LTa h17� <br /> ADDIMS8: 4 C.si na a warNa e. A`Eu R CA �-r -•••� <br /> PHOriLE{7l: <br /> 125- '114H2 76$`F, PHONE(2): <br /> - FAGSlI'QTLE: <br /> TENTA'0`AM-APPOINTMENT DATA: <br /> Time <br /> tPTeaeE3 allow aC busIxaess days from date afaAPllrratian sabmittal-'YanfaSwe y••moist t;e canfleFn¢ } <br /> C� CHrzCtC sox TO PXPEWE RF;RlreST_;45.00 I:eia(CASkI OR GHECK CNLYI-KEQUE§T PRgCIESIN SEp 3;8i1StNE55 fwJR!'S <br /> I <br /> SIGNATURE OF APPL.1 ANT � , ! <br /> RATE 2. _74 6 <br /> 1W!'ectronic Informalion: ❑# [�y{�yap_1�t�Cl Ipt10n� <br /> 9tra9t Street NameADDkilff99 EHL!USE ONLY <br /> Q� <br /> tGSSUnit•149517616( h�,-l�� Rd <br /> 2, ssd C Lcut Se, A-,?c.. <br /> �� .,o � C]•UrEit z <br /> 3. .2. l LovIV r .4�/� Lw f!.✓e <br /> 4. -Lt4 57 Z.ovi.G Avg �<.J Unit3 <br /> S. <br /> 6. <br /> 7. v <br /> $• i Unit 5 <br /> 8. <br /> o. d unit e <br /> 4PROlf lC DOW Range Of Warmation Requested From to <br /> ENVIRONINIENTAL FiF.ALTH DEPARTMENT FIL, S <br /> �1 t VMRG�R.,D�U.N•'bTAW(UST)CLsht�EUp;�nl6'(L0Pj C3 HOUMOADATrmENT b SOU4Wla87EFACSLitY -L a <br /> 1C QMM CWMU P Srta(NON-1.0p) 0 FOOp FAtWY t3 SOUDWAV1 r1=L' _• <br /> ®UNUM0389MVTANK(MQMT01;iPEGMBMWAa,) ppb EHCI n <br /> #HAZARQ8U8 WAMT GtEMSPATQk D AIRY <br /> 0T7 P a+nT�rsi'ACAJrr CNMK14RANctr =WasnMA"NTRrA"uNrpWeT' <br /> 12 fATTOClBp4YPEERCIIIG ©1A4''EU_gjorrL 0 PVMPBR'YRUdLs rAFtWCHffNTomk" <br /> POWSPA <br /> VILPECAL WA TP,FACILITY0 LJWD USE AI 0VgA'nwj anw <br /> ©01MER(PLWE Sp1=GEFY} ; <br /> WGL.LAW $ePTICPEM7'ftccRgg.gRCAYElII.AULrAtOr< vww- 141Emiy-I'M AY8.00AN-S:00PM • FXtLUGtN(;KQ 0AT3. <br /> �. List up to torr addresaas In the spatce ahava. Salert thsa type(s)of files from th&list ahovc by checking thO approdate <br /> box(es)., At least ane fila typo MUST ba sralec;W. I: to z S or mil to the address Indicated 6be p <br /> ranges will not be accepted—for adtflt anW as:ais Nae wi#iL fi19aeldressas,CQAf2ct the EHb.APRlirattlans recWvedddafress <br /> 3.00 Pm will be praCossod the,pext business day. <br /> 2_ Ths EHD Will n0fify thO applicant if any E141)files exist, An eppalntinant for review will be wafirme sf,pTaximafaaiy tan{(py <br /> days after receipt of application, The hies shall be held for a tnaximuni of fhre buslga7Ess alive far revlelty. ,ppalMrnAnta <br /> sbould kin schaadulad aacording(y. . <br /> 3. Aft tJ:at Is actively being worked on by IEHD staff may not be immediE3toly avaHa6te for review. A riew appiicaticn may be <br /> submittsd when tha file Is available. <br /> 4. Any fife not retUrnad in thO same aavnrlition as released will be reorganized by>.HD staff at the expense±of the applicant' <br /> Futuro file reviews by the same applicant Mytaquire q$95.00 dQpasst prior I&ruvlew. <br /> EHD LISA ONLY <br /> i <br /> T9 3�t�d TteZ86L@LET ZT:ZT e902/L9/Z0 <br />